scholarly journals How to Build a Patient-Specific Hybrid Simulator for Orthopaedic Open Surgery: Benefits and Limits of Mixed-Reality Using the Microsoft HoloLens

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Sara Condino ◽  
Giuseppe Turini ◽  
Paolo D. Parchi ◽  
Rosanna M. Viglialoro ◽  
Nicola Piolanti ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Open Surgery ◽  
Mixed Reality ◽  
Training System ◽  
Head Movements ◽  
Face Validity ◽  
Patient Specific ◽  
Visual Fatigue ◽  
Hybrid Simulator ◽  
Audio Perception

Orthopaedic simulators are popular in innovative surgical training programs, where trainees gain procedural experience in a safe and controlled environment. Recent studies suggest that an ideal simulator should combine haptic, visual, and audio technology to create an immersive training environment. This article explores the potentialities of mixed-reality using the HoloLens to develop a hybrid training system for orthopaedic open surgery. Hip arthroplasty, one of the most common orthopaedic procedures, was chosen as a benchmark to evaluate the proposed system. Patient-specific anatomical 3D models were extracted from a patient computed tomography to implement the virtual content and to fabricate the physical components of the simulator. Rapid prototyping was used to create synthetic bones. The Vuforia SDK was utilized to register virtual and physical contents. The Unity3D game engine was employed to develop the software allowing interactions with the virtual content using head movements, gestures, and voice commands. Quantitative tests were performed to estimate the accuracy of the system by evaluating the perceived position of augmented reality targets. Mean and maximum errors matched the requirements of the target application. Qualitative tests were carried out to evaluate workload and usability of the HoloLens for our orthopaedic simulator, considering visual and audio perception and interaction and ergonomics issues. The perceived overall workload was low, and the self-assessed performance was considered satisfactory. Visual and audio perception and gesture and voice interactions obtained a positive feedback. Postural discomfort and visual fatigue obtained a nonnegative evaluation for a simulation session of 40 minutes. These results encourage using mixed-reality to implement a hybrid simulator for orthopaedic open surgery. An optimal design of the simulation tasks and equipment setup is required to minimize the user discomfort. Future works will include Face Validity, Content Validity, and Construct Validity to complete the assessment of the hip arthroplasty simulator.

scholarly journals Towards Virtual VATS, Face, and Construct Evaluation for Peg Transfer Training of Box, VR, AR, and MR Trainer

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Zhibao Qin ◽  
Yonghang Tai ◽  
Chengqi Xia ◽  
Jun Peng ◽  
Xiaoqiao Huang ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Mixed Reality ◽  
Training System ◽  
Patient Specific ◽  
Training Module ◽  
Training Environment ◽  
3D Perception ◽  
Advantages And Disadvantages ◽  
Transfer Training ◽  
Simulation Systems

The aim of this study is to develop and assess the peg transfer training module face, content and construct validation use of the box, virtual reality (VR), cognitive virtual reality (CVR), augmented reality (AR), and mixed reality (MR) trainer, thereby to compare advantages and disadvantages of these simulators. Training system (VatsSim-XR) design includes customized haptic-enabled thoracoscopic instruments, virtual reality helmet set, endoscope kit with navigation, and the patient-specific corresponding training environment. A cohort of 32 trainees comprising 24 novices and 8 experts underwent the real and virtual simulators that were conducted in the department of thoracic surgery of Yunnan First People’s Hospital. Both subjective and objective evaluations have been developed to explore the visual and haptic potential promotions in peg transfer education. Experiments and evaluation results conducted by both professional and novice thoracic surgeons show that the surgery skills from experts are better than novices overall, AR trainer is able to provide a more balanced training environments on visuohaptic fidelity and accuracy, box trainer and MR trainer demonstrated the best realism 3D perception and surgical immersive performance, respectively, and CVR trainer shows a better clinic effect that the traditional VR trainer. Combining these in a systematic approach, tuned with specific fidelity requirements, medical simulation systems would be able to provide a more immersive and effective training environment.

Turning data into reality

2018 ◽  
Author(s):  
S Leinster-Evans ◽  
J Newell ◽  
S Luck
Keyword(s):  
Virtual Reality ◽  
Mixed Reality ◽  
Training System ◽  
Value Proposition ◽  
Immersive Environments ◽  
Training Environment ◽  
Service Support ◽  
Rich Data ◽  
And Training

This paper looks to expand on the INEC 2016 paper ‘The future role of virtual reality within warship support solutions for the Queen Elizabeth Class aircraft carriers’ presented by Ross Basketter, Craig Birchmore and Abbi Fisher from BAE Systems in May 2016 and the EAAW VII paper ‘Testing the boundaries of virtual reality within ship support’ presented by John Newell from BAE Systems and Simon Luck from BMT DSL in June 2017. BAE Systems and BMT have developed a 3D walkthrough training system that supports the teams working closely with the QEC Aircraft Carriers in Portsmouth and this work was presented at EAAW VII. Since then this work has been extended to demonstrate the art of the possible on Type 26. This latter piece of work is designed to explore the role of 3D immersive environments in the development and fielding of support and training solutions, across the range of support disciplines. The combined team are looking at how this digital thread leads from design of platforms, both surface and subsurface, through build into in-service support and training. This rich data and ways in which it could be used in the whole lifecycle of the ship, from design and development (used for spatial acceptance, HazID, etc) all the way through to operational support and maintenance (in conjunction with big data coming off from the ship coupled with digital tech docs for maintenance procedures) using constantly developing technologies such as 3D, Virtual Reality, Augmented Reality and Mixed Reality, will be proposed.  The drive towards gamification in the training environment to keep younger recruits interested and shortening course lengths will be explored. The paper develops the options and looks to how this technology can be used and where the value proposition lies. 

scholarly journals A Novel Suture Training System for Open Surgery Replicating Procedures Performed by Experts Using Augmented Reality

2021 ◽  
Vol 45 (5) ◽  
Author(s):  
Yuri Nagayo ◽  
Toki Saito ◽  
Hiroshi Oyama
Keyword(s):  
Augmented Reality ◽  
Motion Capture ◽  
Open Surgery ◽  
Three Dimensional ◽  
Training System ◽  
Surgical Skills ◽  
Surgical Instruments ◽  
Interrupted Suture ◽  
Education Environment ◽  
Surgical Field

AbstractThe surgical education environment has been changing significantly due to restricted work hours, limited resources, and increasing public concern for safety and quality, leading to the evolution of simulation-based training in surgery. Of the various simulators, low-fidelity simulators are widely used to practice surgical skills such as sutures because they are portable, inexpensive, and easy to use without requiring complicated settings. However, since low-fidelity simulators do not offer any teaching information, trainees do self-practice with them, referring to textbooks or videos, which are insufficient to learn open surgical procedures. This study aimed to develop a new suture training system for open surgery that provides trainees with the three-dimensional information of exemplary procedures performed by experts and allows them to observe and imitate the procedures during self-practice. The proposed system consists of a motion capture system of surgical instruments and a three-dimensional replication system of captured procedures on the surgical field. Motion capture of surgical instruments was achieved inexpensively by using cylindrical augmented reality (AR) markers, and replication of captured procedures was realized by visualizing them three-dimensionally at the same position and orientation as captured, using an AR device. For subcuticular interrupted suture, it was confirmed that the proposed system enabled users to observe experts’ procedures from any angle and imitate them by manipulating the actual surgical instruments during self-practice. We expect that this training system will contribute to developing a novel surgical training method that enables trainees to learn surgical skills by themselves in the absence of experts.

Patient-specific guides improve hip arthroplasty surgical accuracy

2018 ◽  
Vol 21 (10) ◽  
pp. 579-584
Author(s):  
Adeel Aqil ◽  
Sanya Patel ◽  
Anatole Wiik ◽  
Gareth Jones ◽  
Alex Bridle ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Patient Specific

Redesign of the Femoral Stem for a Total Hip Arthroplasty for Additive Manufacturing

2018 ◽  
Author(s):  
Bradley Hanks ◽  
Shantanab Dinda ◽  
Sanjay Joshi
Keyword(s):  
Additive Manufacturing ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lattice Structure ◽  
Stress Shielding ◽  
Patient Specific ◽  
Hip Implants ◽  
Hip Implant ◽  
Total Hip ◽  
Multiple Materials

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

Research and development of a mixed reality and haptic-based dental simulator for tooth preparation and its preliminary evaluation (Preprint)

2021 ◽  
Author(s):  
Yongsheng Zhou ◽  
Yaning Li ◽  
Hongqiang Ye ◽  
Siyu Wu ◽  
Xiaohan Zhao ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Force Feedback ◽  
Mixed Reality ◽  
Skills Training ◽  
Face Validity ◽  
Computer Hardware ◽  
Preparation Process ◽  
Novice Group ◽  
Tooth Preparation ◽  
Skilled Group

BACKGROUND Dental simulator is used in preclinical skills training and virtual reality is the main technology of it. With the development of XR technology, mixed reality appeared and it has significant advantage over virtual reality. OBJECTIVE This study intended to research and develop a mixed reality (MR) and haptic-based dental simulator for tooth preparation and preliminarily evaluate its face validity. METHODS A prototype of MR dental simulator for tooth preparation was innovatively developed by integrating the head-mounted display (HMD), special force feedback handles, foot pedal, computer hardware, and software program. Thirty-four participants were recruited and were divided into Novice group (N=17) and Skilled group (N=17) based on their clinical experience. All participants prepared a maxillary right central incisor for all ceramic crown in the dental simulator, and completed a questionnaire after the preparation to investigate their experience and evaluation toward the dental simulator in aspects of the hardware and software. RESULTS A prototype of MR dental simulator for tooth preparation (Unidental MR Simulator) was newly developed. 73.53% of the participants were satisfied with the overall experience in using Unidental MR Simulator. Over 90% of the participants agreed with that Unidental MR Simulator can stimulate their interest in learning and over 80 % of them were willing to use dental simulator Unidental MR Simulator for skills training in the future. The differences in the experience of the HMD, simulation of the dental instruments, realism of the force feedback of teeth, simulation of the tooth preparation process, overall experience of the simulator and attitudes toward the simulator between Novice group and Skilled group were not statistically significant (P>0.05). Novice group were more satisfied with the ease of use of the simulator. (P<0.05). The resolution of the HMD and the simulation of the preparation process had significant positive correlations with the overall using experience of the simulator (P<0.05). CONCLUSIONS The newly developed dental simulator for tooth preparation, Unidental MR simulator, has a good face validity. It can achieve a higher degree of similarity to the real clinical treatment environment by achieving position adjustment of patients, allowing users to have a better dental skill training experience.

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
pp. 155633162110508
Author(s):  
Zachary Berliner ◽  
Cameron Yau ◽  
Kenneth Jahng ◽  
Marcel A. Bas ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Parkinson Disease ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Categorical Variables ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Increased Risk

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

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